Healthcare Provider Details

I. General information

NPI: 1235865676
Provider Name (Legal Business Name): TAYLOR MICHELLE ANGILLETTA MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E CURRY RD # 307C
TEMPE AZ
85281-2009
US

IV. Provider business mailing address

1100 N PRIEST DR APT 2017
CHANDLER AZ
85226-1020
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-1082
  • Fax:
Mailing address:
  • Phone: 602-750-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number16505
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: